急诊科小儿镇痛和镇静的研究进展

Progress of pediatric pain management and sedation in the emergency department

小儿急诊治疗时常伴有外伤或疼痛.在急诊诊治期间,可能有必要进行某些疼痛或令人不适的诊疗操作.临床上需要急诊科医生为小儿提供安全、有效的镇痛和镇静.为此,我们对国外已发表的相关研究结果做一综述,主要包括以下几个方面：确保在急诊时小儿不会经受长时间或额外的疼痛;使用综合评估工具评估疼痛以分诊患儿;选择适当的药物、剂量和途径,在首次疼痛处理时即提供有效镇痛;尽可能选择无痛苦的方式给药（经鼻、调味糖浆）等;经常再次评估疼痛分数以确保有效镇痛,并留有足够时间来等待药物起效,同时使用非药理和药理的模式镇痛;避免＂常规＂进行一些不必要的致痛的侵入性操作;使用表面麻醉、局部麻醉和区域麻醉连同适当的安全程序镇静,以避免疼痛加剧.

Children usually come to emergency department accompanied with painful conditions and injuries.During the emergence care,additional painful,distressing or unpleasant diagnostic and therapeutic procedures may be required.Emergency doctors are anticipated to provide safe and effective analgesia and se-dation for children.This review summarized recent studies on the following aspects：make sure that children do not experience lengthened or additional pain when coming to emergency medical care;at triage use a com-posite pain assessment tool to assess;aim to provide effective analgesia at the first attempt-use the appropriate drug,dose,and route;choose painless modes of delivery（nasal route,flavoured syrups） if possible;reassess frequently pain scores to make sure that analgesia is effective and allow adequate time for it to work;use non-pharmacological and pharmacological modalities to manage pain;avoid the＂routine＂use of unnecessary painful invasive procedures;use topical,local and regional anaesthesia together with proper safe procedural se-dation to avoid further pain.